NRC Health Transitions Brochure by Chad Sawyer

Bui ldi ng an Ef fect ive Discharge Ca l l Program Identifying Clinical and Service Recovery Opportunities in Real-time

The Roadmap 1. Industry Initiatives ............................................3 2. A Model to Improve Quality, Delivery of Care, and the Patient Experience ............... 4 3. T he NRC Health Transitions Program ...............6

ÂŠ 2015 NRC Health Transitions

Industry Initiatives Improving the patient experience and reducing preventable readmissions are two issues that are, or at least should be, top of mind concerns for every healthcare executive across the country.

1—IMPROVING PATIENT EXPERIENCE Striving to provide excellent patient-centered care is not only the right thing for hospitals to do, it’s detrimental if they don’t. As of fiscal year

HCAHPS STAR RATING

2015, hospitals either gained or lost up to 1.5% of reimbursement based on Hospital Consumer Assessment of Healthcare Providers and Systems

Star Rating

101 582 1414 1205 251

(HCAHPS) scores. In addition to increasing the amount of hospital reimbursement at risk to 2%, the Centers for Medicare and Medicaid Services (CMS) will also continue to expand the service lines included in the Value-Based Purchasing initiative.

r- S fo eFe

v ic eC AH M PS P r e dic ® es ar cr e A i pt ion d va D r nt a ug ge In -C P l an an d en te CA rH HP em S od ® ial Na ys tio is CA nw PH ide S Ad ® ult M Ho ed sp ic a ice id CA PH S ® CA C a PH M re O S ® ed i c a rg a n S u r re i z a v e y I n i t i o fo ti a ns r A Ou ti v es P ar c c ou Su tpa tic rg t i e i p a nt a b e r nt tin le yC a gi A H nd A n PS m CA b ® u l HP a to S ry ® fo rP QR S

lth ea eH m

it a

CMS SURVEY EXPANSION

Number of Hospitals

2008

2—REDUCE READMISSIONS In October 2012, the government’s campaign to reduce readmissions resulted in over $500 million in fines to date with the amount of reimbursement at risk per hospital significantly increasing over time. The penalty program is among the toughest of Medicare’s efforts to pay hospitals for the quality of their performances rather than merely the number of patients they treat. Unlike other new programs, including ValueBased Purchasing, which ties reimbursement to quality indicators and

READMISSION PENALTIES

HCAHPS scores, the readmissions program offers hospitals no rewards

1074

for improvements.

READMISSION REDUCTION PROGRAM OCTOBER 2014

% of Patients Affecting Penalty

100% 90%

Readmission Penalties Increase to 3%

80% 70% 60% 50% 40% 30%

OCTOBER 2015

20% 10% 0%

2011

2015

238

number of hospitals whose readmission penalty did increase number of hospitals not fined

4/5

number of hospitals fined in nearly half of states across the country

2638

number of facilities being penalized for readmissions

Readmission penalties increase to $428 million, up from $227 million in 2014

A Model to Improve the Delivery of Care and the Patient Experience A leading factor in improving the overall patient experience and preventing readmissions is ensuring that patients make a safe transition out of the hospital. A recent study conducted at the Duke University Fuqua School of Medicine found that effective discharge planning is highly correlated to improvement in HCAHPS scores as well as associated with lower readmission rates. The key to being highly effective at discharge planning is through efficient communication with ALL patients post discharge. Following up with every patient post discharge provides organizations with an immediate opportunity to provide clinical or service recovery and real-time patient feedback that can improve the delivery of care for future patients.

HIGH RISK May be included in a discharge call program, but can be excluded if actively managed by Case Management post-discharge.

10–20% MODERATE RISK Always included in a discharge call program with primary goal of

CONTACT 100% OF PATIENTS

identifying clinical risks

While the majority of patients will make a safe and healthy transition

with small number of

from the hospital, research shows that nearly 20% percent of patients

higher risk patients

will require additional transition support. However, high patient volumes

transitioned into Case

and low availability of non-patient care nursing time make it nearly

Management.

impossible to reach out to all patients. In addition to contacting every patient, organizations need a process in place that allows staff to target

40–50%

specific patient populations differently. For example, chronically ill and high risk patients require follow-up calls that address how to continue their care plan outside the hospital, which often involves case management.

LOW RISK

While follow-up calls to moderate and low risk patients need to focus on

Always included in a

mitigating risk and ensure the patient is satisfied with the care and overall

discharge call program

hospital experience.

with primary goal of service recovery with limited percentage of

% THAT MAKE A SAFE TRANSITION HOME

80% of patients

patients experiencing clinical complications.

40–50%

% THAT REQUIRE TRANSITION SUPPORT FOR CLINICAL OR SERVICE NEEDS

20%

of high risk patients

CREATE A STANDARDIZED PROCES In order to maximize resources and see results, healthcare organizations must have a systematic process in place across all patients, areas, and departments. Every patient needs to receive a high quality follow-up call within 72 hours of discharge that addresses the key areas that often lead to health complications. Standardizing the discharge call process is the only way to ensure that calls are made timely and consistently and that patient feedback is quantified and used for rapid process improvement.

ENSURE THE RIGHT PEOPLE ARE MANAGING ISSUES Post discharge calls immediately identify whether and what clinical and/ or service issues patients are experiencing. When executed efficiently, the discharge call process will also allow organizations to effectively allocate resources to ensure that the correct staff member is following up with the right patients. Rather than requiring numerous, sometimes hundreds of clinicians to be trained to conduct discharge calls, organizations will have better outcomes if they leverage technology to assess patients first, then focus their clinical and service resources to only follow-up with the small percentage of high-risk or dissatisfied patients. In addition, highly effective organizations have steps in place to triage higher risk patients to additional levels of care throughout the hospital or healthcare system.

IMPROVING THE DISCHARGE PROCESS USING ANALYTICS

CONTACT RATES WITH AN INTERNAL DISCHARGE CALL PROCESS VS. WITH THE NRC HEALTH TRANSITIONS PROGRAM Organizations that allow units/ departments to decide how follow-up calls are conducted reach significantly less than those that standardize their approach across the system.

14%

100%

Unlike patient satisfaction surveys, patient discharge calls take place in close proximity to the time of service. Therefore, they provide more accurate information regarding: • The patient experience • The discharge process • Transitional care needs • Opportunities for process improvement

BEFORE TRANSITIONS

AFTER TRANSITIONS

14% of patients contacted

100% of patients contacted

Through contacting every patient and having the right people managing patient issues, organizations have access to an invaluable database of real-time patient feedback on care transitions. These metrics provide immediate visibility to gaps in the delivery of care, driving process improvement in areas such as physician communication, medication reconciliation, and the discharge process.

The NRC Health Transitions Program NRC Health Transitions is the leading provider of discharge call solutions. Transitions combines a responsive technology platform with proven processes and best practices to allow healthcare organizations to meet key performance measures, including reducing readmissions and improving HCAHPS scores.

NRC HEALTH TRANSITIONS PROCESS AND ALERT MANAGEMENT

In use by hundreds of healthcare organizations, Transitions ensures 100%

Patient Discharged home

patient contact within 72 hours post discharge, rapid clinical and service recovery, and that patient feedback is converted into real-time statistically significant data for tracking, trending, benchmarking, and overall process

First contact attempt is made within 72 hours of discharge

improvement across the healthcare continuum.

PREFERENCE BASED COMMUNICATIONS FOR REAL-TIME FEEDBACK

Alert Triggered? Y/N

Realizing that only 20% of patients require additional attention, the NRC Health Transitions Platform leverages multi-channel outreach to drive communication between the hospital and the patient. With Transitions, hospitals gain immediate visibility to high-risk patients, the ability to ensure the most appropriate staff member addresses patient issues, and access to detailed patient profiles that drive efficient clinical and service recovery.

LEVERAGING ANALYTICS FOR PROCESS IMPROVEMENT

Yes Designated staff call patient to verify and resolve issues

Data Collected is Included in Report and available in Transitions reporting system

Designated staff updates Alert Tracker and closes out patient record

Unlike satisfaction surveys, the NRC Health Transitions program ensures that patient discharge calls take place in close proximity to the time of service. They provide more accurate information about the patient experience, the discharge process, issues that can impact patient care,

Data included in Transitions reporting system

opportunities for improvement and areas where improvements are being made. Through utilizing the Transitions Platform, organizations are able to collect data and push reports to leadership, unit managers, and other key decision makers. As changes are made, the organization will continue to have data that supports the impact of the improvements.

ÂŠ 2015 NRC Health Transitions ÂŠ 2015 NRC Health Transitions

NRC HEALTH TRANSITIONS BENCHMARK DATA

1. TRANSITIONS REPORT: Quality metrics and key drivers leading to patient clinical and service issues

1 IN 5

ushed to Chief Nursing P Officer, Nursing Leadership and Readmission Committees

Patient Outreach Alerts

Patients readmitted within 30 days post discharge

8% Patients need assistance with making follow-up appointment

2. ALERT TAG REPORT: Text analysis of patient feedback to uncover gaps in the delivery of care and opportunities for process improvement

Pushed to Chief Quality Officer, Quality Directors, and Readmission Committees

Patients with questions or concerns regarding medications

Meds Instructions

12% Patients don’t understand their discharge instructions

ADDITIONAL REPORTS

3. SNAPSHOT REPORT: Overview of hospital and unit performance including trending and benchmarking on transition issues Pushed to Chief Nursing Officer, Chief Quality Officer, and other Senior Leadership

Compliments Report Accountability Report Unit and Leadership Dashboard Reports

Patient Outreach/Alerts

Partnering with NRC Health: A Return on Investment A large driver of patients’ overall satisfaction and an organization’s readmission rates is whether or not a patient makes a safe transition

HCAHPS IMPROVEMENT Post discharge calls easily identify

from the hospital. Therefore, hospitals and health systems that have a standardized discharge call process in place have significantly higher HCAHPS scores than those that do not have a standardized discharge call process in place.

gaps in the discharge process

For example, after implementing Transitions, a 500 bed hospital in New

and barriers that patients face

York saw significant impact on HCAHPS scores and gained the ability

post discharge. Therefore, they

to collect accurate, quality feedback from patients to drive process

have the most significant

improvement and service recovery.

impact on the following HCAHPS questions:

EFFECTIVENESS OF NRC HEALTH TRANSITIONS PROGRAM ON HCAHPS SCORES When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.

56%

70%

69%

72%

67% 62%

61%

58% 56% Year 2

Year 3

When I left the hospital, I clearly understood the purpose for taking each of my medications:

Year 4

63%

Year 1 Year 2

Year 3

During this hospital stay, the staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left.

Year 2

Year 3

Year 4

Year 2

Year 3

Year 4

HOSPITAL RATING

Year 1

Year 2

Year 3

Year 4

WOULD RECOMMEND

47%

Year 4

USING DATA FOR PROCESS IMPROVEMENT Effective post discharge phone call programs also provide organizations with an invaluable database of patient feedback. When captured and executed on, this information leads to improved processes and safer patient transitions over time, resulting in a better delivery of care model, higher HCAHPS scores, and a reduction in high risk patients over time.

NRC HEALTH TRANSITIONS HCAHPS IMPACT ON IDENTIFYING PATIENTS WITH SERVICE ISSUES 75%

16% 14%

70%

12% 10%

65%

8% 6%

60%

4% 2%

55%

0% 50%

YEAR 1

YEAR 2

Would Recommend

YEAR 3

YEAR 4 % of Patients with Service Alerts

Hospital Rating

SERVICE RECOVERY NRC Health Transitions provides a standardized, systematic approach where leadership can be confident that the most appropriate staff is responsible for any clinical and/or service recovery. Staff are chosen based on their skill set and provided with additional training to ensure they are able to listen, acknowledge, and rectify any issues.

EFFECTIVENESS OF SERVICE RECOVERY USING NRC HEALTH TRANSITIONS

.69 .62 .55

.59 .66

.57

.58

YEAR 2

YEAR 3

.49

YEAR 1

Would Recommend

YEAR 4

Hospital Rating

About NRC Health Transitions NRC Health Transitions leverages technology to drive effective communication between healthcare providers and patients in the critical 24-72 hours post discharge by: ➞ Providing immediate visibility to patients at risk for a readmission ➞ Reporting patient level assessment data and historical patient profiles so that the patient’s issues can be resolved efficiently by the appropriate member of the care team ➞ Tracking, trending and benchmarking to isolate the key areas for process improvement allowing organizations to implement changes and reduce future readmissions NRC Health ensures that your discharge call program contacts 100% of patients within the critical initial 24-72 hours post discharge. Through preference-based communications and real-time alerting, our Transitions solution enables organizations to identify and manage high risk patients to reduce readmissions, increase patient satisfaction, and support safe transitions.

About NRC Health NRC Health has helped healthcare organizations illuminate and improve the moments that matter most to patients, residents, physicians, nurses, and staff for 35 years. Our empathetic heritage, proprietary methods, and holistic approach enable our partners to better understand the people they care for and design experiences that inspire loyalty and trust.

(800) 388-4264 nrchealth.com